DESCRIPTION: (Provided by the Applicant) Over 5 million people who suffer preventable morbidity and mortality are admitted annually in the U.S.; consuming about 30 percent of acute care costs ($180 billion annually). Previous studies suggest that nearly every ICU patient suffers a potentially life threatening adverse event. To reduce this, we must learn what is broken and fix it. We hypothesize that we can improve patient safety; improve safety culture; and reduce ICU mortality, blood stream infections, aspiration pneumonia and ICU length of stay. To accomplish this, we will partner with the Michigan Hospital Association, whose has over 130 Michigan hospitals, to implement a safety program and other interventions in a cohort of hospitals. The specific aims of this project are to implement and evaluate the: (1) impact of the Comprehensive Unit-based Safety Program that includes the ICU Safety Reporting System; (2) effect of an intervention to improve communication and staffing in ICUs; (3) effect of an intervention to reduce/eliminate catheter related blood stream infections in ICU s; (4) effect of an intervention to improve the care of ventilated IC patients; and (5) effect of an intervention to reduce ICU mortality. To implement these aims, we will develop interventions for MHA who will then interact with Michigan hospitals to implement these interventions. Hospitals must commit a team--including a senior executive (vice-president or above), an ICU director or ICU physician, ICU nurse or nurse manager, and a department administrator--to collecting required data and attending 2 meetings and 2 conference calls/year. All teams will work on specific aim 1 and then choose one of the other specific aims every 6 months. By the end of the two year project, each team will have implemented all 5 specific aims and able to coach each other. Successful completion of this project will lead to significant improvements in patient safety across a state.